A RARE CO-EXISTENCE OF CORONARY ANOMALIES: ANOMALY OF ORIGIN AND DISTRIBUTION TOGETHER WITH ANOMALY OF INTRINSIC CORONARY ARTERY ANOMALY: A CASE REPORT
Abstract
The co-existence of the Left Circumflex Coronary Artery (LCx) originating ectopically from the right sinus of Valsalva with a Posterior Descending Coronary Artery (PDA) originating from the distal end of the Left Anterior Descending Artery (LAD) i.e. a hyper dominant LAD is, to our knowledge, unreported previously.
We describe, a case admitted to our institution with the diagnosis of acute coronary syndrome /NSTEMI/ and coronary arteriography unveiling anomalous origin of a Left Circumflex Coronary Artery from the right coronary sinus of Valsalva near the right coronary ostium AND a Hyperdominant LAD giving off a PDA with small distal Posterolateral Left ventricular branch. This rare co-existence of anomaly is important to keep in mind and be cognizant of the extensive myocardium this type of coronary anomaly perfuse and should be anticipated with high index of suspicion if a patient presents with extensive anterior and inferior wall left ventricular myocardial infarction, which is a common clinical scenario.References
Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990;21:28-40.
Wilkins C E, Benjamin B, Mathur VS etal. Coronary Artery Anomalies, A Review of More than 1 0,000 Patients from the Clayton Cardiovascular Laboratories. Texas Heart Institute Jn1988, 15 166-173
Angelini P, Coronary artery anomalies, current clinical issues. Texas Heart Institute J 2002; 29:271-8)
D Dursunoglu, G Ozalp, O Taskoylu, E Semiz. Anomalous origin of the left circumflex coronary artery; A case report. Exp Clin Cardiol 2007; 12 (4) : 207-208
Page HL Jr, Enjel HJ, Ampbell WB, Thomas CS Jr. Anomalous origin of the left circumflex coronary artery. Recognition, angiographic demonstration and clinical significance. Circulation 1974;50:768-73.
Rozenman Y, Schechter D, Gilon D, MS Gotsman: Anomalous origin of the circumflex coronary artery from the right sinus of valsalva as a cause of ischemia at old age, clin. cardiol. 1993, 16:900-901
SC Plastiras, OS Kampessi, et al, Anomalous origin of the left circumflex coronary artery from the right coronary artery: case report. cases journal 2008 1:336
Javangula K, Kaul P. Hyperdominant left anterior descending artery continuing across left ventricular apex as posterior descending artery coexistent with aortic stenosis. J Cardiothorac Surg 2007;2:42.
Watanabe T, Tamura A, Torigoe K. Unusual long left anterior descending coronary artery with a posterior “ascending” branch. Int J Cardiol 2013;163:e17–8.
KangWC, Shin EK. Acutemyocardial infarctionwith simultaneous ST-segment elevation in the precordial and inferior leads due to unusually very long LAD extended to posterior wall of LV. Clin Cardiol 2009;32:E36–7.
Deora S, Shah S, Patel T. Super dominant left anterior descending artery continuing as posterior “ascending” and posterior left ventricular branch: A rare coronary anomaly. International Journal of Cardiology 168 (2013) e121–e122
Cingoz F, Bingol H, Turan A, Tatar H. Left anterior descending artery arising as a terminal extension of posterior descending artery (a rare coronary anomaly). interactive cardiovascular and thoracic surgery 2 (2003) 680-681
Grossman & Baim’s Cardiac Catheterization, Angiography and Intervention. Mauro Moscucci, 8th Edition, Chapter 16, pp 335-353.
